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All the data of biographical andexpert interviews were collected by the author of the research in St. Petersburg and theLeningrad region. The choice of research locations was based on the search forcontrasting places. For example, at the beginning of the study, it was suggested that therewere differences in everyday practices and the identity formation of young physicians ina federal city / small town / village. The development of the problem of research andtools, the research question and the method of data analysis was carried out by the authorhimself and corrected in the framework of appropriate consultations with the academicsupervisor.Main findings-Integration into the profession of physicians begins in early childhood and isconditioned by the first child's play practices in everyday life, then the period of schoolsocialization comes. In the study, we distinguish two strategies: a generational strategyand an individual choice strategy.
Both strategies are characterized by certain types ofidentity and the view to the medical profession. Representatives of the generationalstrategy most often constructed their professional identity based on symbolic meaning ofthe medical profession while the representatives of individual choice strategy constructedtheir professional identity on instrumental meanings of the medical profession.-The subsequent stage of integration into the medical profession is conditioned bythe studies in a medical university. This stage is important from the point of view of bothformal everyday practices in the context of studies and informal everyday practices.Moreover, the practices of during the formal socialization are disciplinary and were oftendefined by young physicians in interviews as those practices that do not promoteintegration into the profession, as opposed to informal practices caused by interactionwith colleagues, classmates and informal communication on medical topics, integrationinto professional culture.- The next stage of integration into the profession is conditioned by the firstprofessional practices and integration into professional practices within the framework ofthe work.
Formation of professional identity at this stage of development is due to work12in a private clinic / budget polyclinic or hospital and to the way a young physician seeshis/her subsequent development.- Each of the types of professional identity identified in the study is characterizedby its life strategies identified by us and defined by the continuum from traditional viewson career and personal life to innovative ones.- The most vulnerable in the context of the instability of professional employmentof physicians are the following identity types: the "specialist-scientist", the "specialistpsychologist". In general, the problems of employment, typical for physiciansrepresentatives of these types of identity, are due to the fact that clinics and hospitals in alarge federal city do not require general practitioners but require medical specialistsusually focused on practical activities, and not on scientific work.
Accordingly, in thecontext of a village / small town, if a general practitioner leaves the village, the problemof finding a job in a large megalopolis arises.- In the federal city the most dominant are the "specialist-expert" and "specialistscientist" identity types, representatives of these identity types are characterized by aninnovative life strategy and freelancing strategy, largely due to the specifics of the jobmarket and the socio-economic situation of young physicians. The "specialistpsychologist" identity type is found mainly in budget polyclinics in the city, this identitytype is characterized by low professional ambitions and vital strategy of traditionalists.- Depending on the location and the area development (the study was carried out incontrast cases, the Luzhsky district is the developed agrarian sector, meat and dairyanimal farming, Podporozhsky district is industrial depressive district today), there aredifferent dominant life strategies and types of professional identity of young physiciansin the village / small town.
For the agrarian region, the "specialist- psychologist" is mostcommon type of professional identity – young physicians of this type living in the district– are adhered to the rural life strategy and showed low professional ambitions.- When planning their life strategy, rural young physicians and young physiciansfrom the small towns consider it important to have an idea of their role in the localcommunity and individual positioning themselves as a specialist in the local communityof a village or a small town and working with rural patients, due to specific characteristics.13In villages and small towns, the main problem of the work of doctors, which also affectsthe motivation to continue to work in the profession or to leave the profession is acognitive dissonance conflict of the roles of the doctor (specialist and rural resident).
Thesolution to this conflict can be both positive when the doctor tries to integrate into thevillage and rural everyday life, defining his professional identity in the context ofassistance to rural residents, and negative – the creation of a maximum distance, themaximum "separation" of his professional identity from the identity of the rural resident.A negative solution to the conflict, as a rule, serves as an excuse to move back to the city.This conflict is more pronounced in villages than in small towns - where the work of adoctor can be defined as more urban.- All life strategies of young physicians are characterized by the positioning ofmedical knowledge and acquired medical knowledge during studies as an importantresource.
At the same time, the value of medical knowledge can be determined by thevarious "poles" of professional and personal implementation, starting with the traditionalposition of the "doctor-savior" role and assistant and ending with an innovative look atthe medical profession, where the young physician positions himself as a scientist. In thiscase, the professional ambitions indicated by us in the study as low or high are indicative.Each identity type and each life strategy has different vectors of professional ambitionsand plans for further career development.- Summing up, we can talk about professional identity in the context of anindividual life world (the life strategy of a young physician).
The research usesphenomenological and socio-anthropological approaches to the study of professionalidentity, which allowed us to typify life strategies and identify types of professionalidentity based on differences in everyday practices. Professional identity can be definedas an individual value (resource). This resource – the development of medical knowledgefrom getting education to realizing life-style strategy – is becoming one of the few areasof reliable investment, and the expansion of professional knowledge both in the contextof hobbies, everyday life and during professional practices determines the developmentof a young physician and the solution of the problem of instability in the modern healthcare sphere, as well as the avoidance of bureaucratization and formalization of the14processes of working with patients when the physician becomes a machine for filling outpaperwork.General conclusion from research1.
It is established that the dominant motive for choosing a medical professionamong young physicians is the interest in this profession. And this interest appears in theframework of everyday practices that are close to professional requirements, and then istransformed into a "special" attitude to this profession.2. It is shown that educational socialization within the framework of studies in amedical university does not influence the motivation of a young physician to stay in theprofession. This socialization has a formal disciplinary nature, and it is the firstprofessional practices, work in the clinic that help the young physician define himself inthe profession and motivate him to change his profession or continue his work byprofession.3.
An important role in the process of forming a professional identity is played byeveryday practices and positioning of identity in a federal city, a small town and a village.The city is characterized by a special medical symbolism associated with special placesand medical culture (medical spaces). Young physicians in the villages and small townsof the Leningrad Region defined their professional identity based on the possession of"special" knowledge and professional practices that are extremely necessary in thesespaces. At the same time, there are two polar views on positioning oneself in a village ora small city: the inclusion strategy determined by the desire to continue working in a smalltown or village and the strategy of moving determined by the desire to move from thevillage.4. The professional identity and positioning of a young physician as a professionalis different in terms of the territorial character of the work.
The work of a physician in afederal city is largely determined by the biomedical model of physician-patientinteraction, as well as alienation from the emotional aspects of professional activity. Thework of a physician in a village and in a small town is largely determined by his/herinclusion or non-inclusion in the rural community and, as a consequence, the motivation15for moving from rural areas. At the same time, the professional practices of a youngphysician in a village and a small town are characterized by multitasking, in contrast tourban practices, where narrow specialization and expertise in a particular field play a keyrole.5. There are three basic types of life strategies for young physicians, typical for afederal city and village / small town.
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